For 45 minutes, my dad and I quickly received an online education about avascular necrosis, or AVN. It was not common. It usually affected men more than women. Known causes are excessive alcohol intake, and long-term high-dose steroid use. About 35% of cases are idiopathic- no known cause. I was a drug addict, but I did not have excessive alcohol intake, and the steroids I had over the past few months, while it was a lot, wasn't long-term or high dose. As far as treatments- well there weren't much. AVN turns out to be a very challenging disease because there is no medical management, and the surgical interventions vary greatly in their success rates. There is core decompression, bone resurfacing, bone grafting (transplant)... The only "successful" treatment is a total hip replacement (THR). "Successful" because it removes the dead bone completely and replaces the joint with a prosthesis. But even that doesn't fix the problem for good, because the materials used for THRs wear out over time. The younger you are, theoretically, the more revisions you will need. The less impact you put on the artificial hips, the longer they last. So depending on how long you want your new hips to last, your high impact activity may be limited.
An hour later we were in Dr #4's office. He was loud and a bit arrogant. But it didn't bother me. My dad was a surgeon, and I had worked with this personality for years. I was actually quite impressed with the time he spent with us. He explained that my MRI showed that my left hip had about 35-40% necrosis and the right side had 30-35%- both of which are pretty large lesions. The regular x-rays showed that the femoral heads were still the correct shape- rounded. When the necrosis gets bad enough, the bone will eventually collapse, which will cause more pain and difficulty with range of motion and weight bearing. Once the bone collapses, the only choice is to do a THR. The choice about other treatments- to avoid or postpone the need for THR- is the controversial one. In his opinion, none of the other interventions had a good enough success rate to justify trying. Basically, his thought was that when the pain got unbearable, the best option would be to do the THR. At this time, this made sense to me.
Dr #4 was concerned about a number of things. First, I was a mess in his office. I was crying and very emotional. I had already been depressed, this certainly didn't help my outlook at this point. He observed this and said that I needed time to let this all sink in and get emotionally prepared for the surgery and recovery. I was a little bit embarrassed- yes I was pretty shaken up. But I am not by any means a weak person in general. At this moment in time, I appeared to be falling apart. I remember him doing something that was pretty powerful- he grabbed hold of my hands and looked me in the eyes and said "Look- this isn't cancer and it isn't a massive heart attack. You won't die from this. And young patients with THRs live as full a life as they did before the surgery."
Second, the pain issues. I was still having sciatica pain. He was concerned that if I had this after surgery, it might negatively affect my recovery and make physical therapy difficult. Third, he knew that I had back surgery just a month and a half ago and said it would be better to wait a bit before jumping into another surgery so soon. Fourth, my smoking. It was absolutely imperative that I quit. Nicotine constricts blood vessels. It could be speculated that my 20+ years of smoking contributed to the AVN- by repeatedly constricting my blood vessels, it could have affected the blood supply to my hips. But more importantly, good healing needs good blood flow- especially when my bone will need to heal well around the implants. In addition to the healing aspect, there are other concerns with my lungs and anesthesia, and the formation of blood clots.
He wanted to see me in another 6 weeks, with the goals to be that in this time period, my sciatica would be improved, I would be mentally prepared to go forward with surgery, and that I would quit smoking. I felt this was all reasonable and made good sense.
Driving home, I felt absolutely exhausted. It was so much new information. I was scared. I was worried. All I wanted to do was smoke a pack of cigarettes. Quitting smoking seemed almost impossible. I was overwhelmed by all of these emotions. I had these horrible visions of me being grossly overweight and wheelchair bound and living in a trailer with a dozen cats on a disability income. Which was totally ridiculous. I went home and got in bed. I didn't really talk to anyone for a few days. I needed to cry and yell and throw things. I needed to go through the emotions. It was sort of like Elisabeth Kubler Ross's stages of grief. This wasn't easy for me. I am a drug addict. For years, I coped with uncomfortable feelings by taking drugs to mask them. I numbed out. That wasn't an option for me anymore. I had to reach down deep, and use the coping mechanisms I had learned since becoming clean. This was the hardest thing I had gone through since then, and it was going to be a hell of a challenge.